Mohamad Hassan, PT, DPT, diagnoses neuromuscular and orthopedic conditions, including sprains, strains, and post-operation fractures and tears.
Spinal fusion and disc replacement are two surgical methods used to treat certain types of spine disease, especially degenerative disc disease (DDD). Each type of surgery has its risks and benefits and involves recovery time and rehabilitation.
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As a structure, the spinal column is made of stacked vertebral bones separated by spinal discs. Each disc is composed of tough, but pliable collagen fibers that help maintain the position and integrity of the spine while allowing movement between the vertebrae. This complex structure provides us the stability needed to stand upright, as well as the flexibility to bend and twist in multiple directions.
With DDD, the spinal discs that rest between the bones of the spine wear away. This can be due to various reasons, such as old age, daily activities and sports, or injuries. To an extent, this type of deterioration is normal; most people by age 60 will experience it to some degree.
People can have disc degeneration that doesn't cause any problems, but sometimes, it can lead to pain.
Though the two surgeries have similar aims, there are important differences between them. In short, disc replacement is a newer, less-proven approach, but it may have advantages compared to spinal fusion.
Before considering surgery, treatment for DDD should focus on non-invasive or minimally invasive options. Surgery for DDD is typically considered when conservative methods like physical therapy and anti-inflammatory medication don't provide relief.
Spinal fusion has been the standard surgical treatment for DDD when surgery is needed. The goal for spinal fusion is to correct deformities of the spine by fusing two or more vertebrae together to increase stability and decrease motion that may be causing pain.
In a spinal fusion procedure, a damaged disc can be removed and replaced with a bone graft to stimulate bone growth. Over time, the space of the absent disc gradually fills with bone, fusing the vertebrae.
On the other hand, lumbar disc replacement is similar to other types of joint replacement, such as those involving the knee or hip. The surgery involves removing a damaged disc and replacing it with an artificial disc that mimics a healthy one, which can preserve the spine's mobility.
There are pros and cons to both surgical methods. Spinal fusion has been a standard procedure for spinal conditions since the 1890s. Conditions like DDD can cause the vertebrae of your spine to move poorly, be unstable, and absorb more load than normal, causing pain. Spinal fusion may help eliminate pain by stabilizing the spine and limiting pain-causing movements of one or more vertebrae.
However, because adjacent bones are joined together in a spinal fusion—eliminating all movement in that level of your spine—the way your spine moves after the operation may be altered, with extra pressure being placed on the adjacent joints.
Problems with spinal fusion surgery can also include:
Degeneration in spinal joints above and below the site of a spinal fusion is commonly known as adjacent segment degeneration (ASD).
Total disc replacement surgery is intended to preserve your spine’s mobility and help reduce post-surgical degenerative changes in the neighboring spinal joints.
However, this does not suggest that lumbar disc replacement surgery is not without its own limitations.
When comparing the two procedures, some research shows that there is not much of a difference when it comes to success rates.
A 2015 study published in the Asian Spine Journal found that re-operations and revision surgeries were needed at about the same rate regardless of whether the initial surgery was a cervical disc replacement or a cervical discectomy with spinal fusion.
However, emerging research suggests that disc replacement surgery may be a potentially more beneficial procedure than spinal fusion surgery.
A 2017 study published in the Global Spine Journal compared outcomes between lower back total disc replacement and lower back fusion surgery. The researchers found that disc replacement patients showed more improvements in pain relief and disability than spinal fusion patients at every post-surgery time period studied (six weeks, three months, six months, and one year).
In addition, two 2020 systematic reviews, one published in the journal Turkish Neurosurgery and the other in the journal Medicine, found that disc replacement surgery yielded better results in factors like pain and range of motion when compared to spinal fusion.
With that being said, the potential benefits of a disc replacement surgery compared to spinal fusion can sometimes make disc replacement the preferred treatment option.
Not everybody is eligible for disc replacement or spinal fusion surgery.
Your doctor may recommend disc replacement surgery if:
Your doctor may not recommend total disc replacement surgery if you have conditions like:
Additionally, a total disc replacement surgery may not be recommended if you have a history of adverse or allergic reactions to implant material.
Similar to total disc replacement surgery, your doctor may recommend spinal fusion if you've had no prior joint or spinal conditions and haven't had spinal surgery before. Your doctor may not recommend spinal fusion if you have conditions like severe adjacent segment disease or non-symptomatic spondylolysis.
The cost of disc replacement surgery can range anywhere from $30,000 to $45,000 or more depending on location and if more than one spinal disc needs to be replaced.
Similarly, the cost of spinal fusion can range from $73,000 to $82,000 or more, but costs can vary due to location and the nature of the procedure—for example, if multiple vertebrae need to be fused.
Spinal fusion and disc replacement surgery are two surgical methods utilized for spine disease, especially DDD. Although some studies show that the success rates of both surgical procedures are about equal, emerging research shows that there may be more potential benefits with total disc replacement surgery, such as preserved mobility and decreased pain.
However, it's important to talk with your doctor to see which procedure would be best for your condition and lifestyle.
If you develop severe back pain of any sort and believe it may be DDD, it's important that you get evaluated by an orthopedic specialist to pinpoint the exact cause. You may be able to avoid surgery and alleviate problems with conservative measures like anti-inflammatory medications, physical therapy, and epidural steroid injections.
Be sure to talk thoroughly with your doctor about the risks and benefits of a spinal fusion or disc replacement surgery if you're considering surgery.
The effectiveness of disc replacement or spinal fusion surgery can depend on different factors. However, current research suggests that total disc replacement surgery may have more potential benefits, like preserved mobility and decreased postoperative pain compared to spinal fusion.
However, not everyone with spinal issues is a candidate for either procedure, and more research is needed to conclude if total disc replacement surgery is more effective.
Sometimes, yes. A surgeon may consider disc replacement surgery if a previous spinal fusion surgery failed and you're a good candidate for a disc replacement.
There are 23 discs in your spine.
For either surgery, you'll probably need to stay in the hospital for a few days after the procedure. Your doctor will give you pain medication as needed. You may also be encouraged to stand, walk, and perform specific rehabilitation exercises soon after either procedure.
Your healthcare provider will advise you on other specifics, such as a plan for your diet and gradual return to activities.
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Cedars Sinai. Degenerative disc disease.
American Academy of Orthopaedic Surgeons. Spinal fusion.
John Hopkins Medicine. Minimally invasive spinal fusion.
Health Quality Ontario. Cervical artificial disc replacement versus fusion for cervical degenerative disc disease: A health technology assessment. Ont Health Technol Assess Ser. 2019;19(3):1-223.
Virk S, Qureshi S, Sandhu H. History of spinal fusion: Where we came from and where we are going. HSS J. 2020;16(2):137-142. doi:10.1007/s11420-020-09747-7
Cleveland Clinic. Is spinal fusion right for you?
Texas Back Institute. History of Texas Back Institute.
Skovrlj B, Lee DH, Caridi JM, Cho SK. Reoperations following cervical disc replacement. Asian Spine J. 2015;9(3):471-482. doi:10.4184/asj.2015.9.3.471
Mattei TA, Beer J, Teles AR, Rehman AA, Aldag J, Dinh D. Clinical outcomes of total disc replacement versus anterior lumbar interbody fusion for surgical treatment of lumbar degenerative disc disease. Global Spine J. 2017;7(5):452-459. doi:10.1177/2192568217712714
Li YZ, Sun P, Chen D, Tang L, Chen CH, Wu AM. Artificial total disc replacement versus fusion for lumbar degenerative disc disease: An update systematic review and meta-analysis. Turk Neurosurg. 2020;30(1):1-10. doi:10.5137/1019-5149.JTN.24799-18.2
Zhai S, Li A, Li X, Wu X. Total disc replacement compared with fusion for cervical degenerative disc disease: A systematic review of overlapping meta-analyses. Medicine (Baltimore). 2020;99(19):e20143. doi:10.1097/MD.0000000000020143
John Hopkins Medicine. Lumbar disk replacement.
Büttner-Janz K, Guyer RD, Ohnmeiss DD. Indications for lumbar total disc replacement: Selecting the right patient with the right indication for the right total disc. Int J Spine Surg. 2014;8:12. doi:10.14444/1012.
Omidi-Kashani F, Hasankhani EG, Ashjazadeh A. Lumbar spinal stenosis: who should be fused? An updated review. Asian Spine J. 2014;8(4):521-530. doi:10.4184/asj.2014.8.4.521
Motion Spine Institute. The human spine.
John Hopkins Medicine. The road to recovery.
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